Provider Demographics
NPI:1124221304
Name:JAIN, RAKESH (MD)
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HERITAGE OAK CT
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4961
Mailing Address - Country:US
Mailing Address - Phone:979-480-9886
Mailing Address - Fax:979-480-9997
Practice Address - Street 1:461 THIS WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5143
Practice Address - Country:US
Practice Address - Phone:979-480-9886
Practice Address - Fax:979-480-9997
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ05402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXY0079715OtherDEPT OF PUBLIC SAFETY
TXY0079715OtherDEPT OF PUBLIC SAFETY
F57878Medicare UPIN